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1.
J Alzheimers Dis ; 81(2): 607-617, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33814446

RESUMEN

BACKGROUND: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. OBJECTIVE: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. METHODS: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. RESULTS: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. CONCLUSION: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.


Asunto(s)
/psicología , Cuidadores/psicología , Demencia/psicología , Aislamiento Social/psicología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Brasil , Chile , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Encuestas y Cuestionarios
2.
J Alzheimers Dis ; 80(4): 1713-1721, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33646163

RESUMEN

BACKGROUND: From March 2020, the support and care systems for caregivers and people with dementia (PWD) were suspended or dramatically changed due to the lockdown during the world pandemic of COVID-19. Thus, these changes in living conditions have had deleterious consequences on the behavior of PWD and subsequently on their caregivers' mental health, the two being linked. OBJECTIVE: Our study aimed to examine changes in behavior among PWD and to look for associations between the evolution of behavioral and psychological symptoms of dementia (BPSD) and caregivers' mental health in the context of COVID-19. METHODS: The study was conducted among caregivers of PWD living at home in France. Caregivers were interviewed via an anonymous cross-sectional online survey during the first lockdown between April 15 and June 15, 2020. RESULTS: Three hundred and eighty-nine caregivers accompanying a relative living at home participated in the study; 43.3%of the PWD presented a worsening of BPSD during the lockdown. With multivariate logistic regressions, a significant association was observed between "more BPSD" and burden, anxiety and depression, between "BPSD equivalent" and anxiety and depression, and between "emerging BPSD" and only depression. CONCLUSION: The lockdown seems to have an impact on behavioral disorders in PWD and these disorders are associated with poorer mental health of caregivers. Our findings suggest attention should be given to caregivers of PWD who have BPSD before lockdown and the need for continued consultations and professional help in case of new lockdowns.


Asunto(s)
/psicología , Cuidadores/psicología , Control de Enfermedades Transmisibles , Demencia/psicología , Trastornos Mentales/psicología , Salud Mental , Anciano , Anciano de 80 o más Años , Cuidadores/tendencias , Control de Enfermedades Transmisibles/tendencias , Estudios Transversales , Demencia/epidemiología , Femenino , Francia/epidemiología , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental/tendencias , Persona de Mediana Edad , Encuestas y Cuestionarios
3.
J Alzheimers Dis ; 80(4): 1705-1712, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33646168

RESUMEN

BACKGROUND: The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers. OBJECTIVE: We aim to evaluate the neurological decline of patients with dementia and the caregivers' burden during the pandemic. METHODS: We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers' report: with perceived Altered Cognition (AC) and Stable Cognition (SC). RESULTS: A total of 58 patients (median age: 57 years [21-87], 58.6%females) and caregivers (median age: 76.5 years [55-89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p < 0.001) changes when compared to the SC group. In the AC group, ZBI, BDI, NPI-Q caregiver distress, and NPI-Q patient's severity of symptoms scores were worse than the SC group (p < 0.005 for all). CONCLUSION: Patients' neuropsychiatric worsening and caregiver burden were frequent during the pandemic. Worsening of cognition was associated with increased caregivers' psychological distress.


Asunto(s)
/psicología , Cuidadores/psicología , Demencia/psicología , Trastornos Mentales/psicología , Distrés Psicológico , Aislamiento Social/psicología , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , /epidemiología , Cuidadores/tendencias , Estudios Transversales , Demencia/diagnóstico , Demencia/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Servicio Ambulatorio en Hospital/tendencias , Pandemias , Adulto Joven
4.
J Alzheimers Dis ; 80(4): 1395-1399, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33646169

RESUMEN

The rapid emergence of COVID-19 has had far-reaching effects across all sectors of health and social care, but none more so than for residential long-term care homes. Mortality rates of older people with dementia in residential long-term care homes have been exponentially higher than the general public. Morbidity rates are also higher in these homes with the effects of government-imposed COVID-19 public health directives (e.g., strict social distancing), which have led most residential long-term care homes to adopt strict 'no visitor' and lockdown policies out of concern for their residents' physical safety. This tragic toll of the COVID-19 pandemic highlights profound stigma-related inequities. Societal assumptions that people living with dementia have no purpose or meaning and perpetuate a deep pernicious fear of, and disregard for, persons with dementia. This has enabled discriminatory practices such as segregation and confinement to residential long-term care settings that are sorely understaffed and lack a supportive, relational, and enriching environment. With a sense of moral urgency to address this crisis, we forged alliances across the globe to form Reimagining Dementia: A Creative Coalition for Justice. We are committed to shifting the culture of dementia care from centralized control, safety, isolation, and punitive interventions to a culture of inclusion, creativity, justice, and respect. Drawing on the emancipatory power of the imagination with the arts (e.g., theatre, improvisation, music), and grounded in authentic partnerships with persons living with dementia, we aim to advance this culture shift through education, advocacy, and innovation at every level of society.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/tendencias , Demencia/epidemiología , Demencia/terapia , Cuidados a Largo Plazo/tendencias , /psicología , Control de Enfermedades Transmisibles/métodos , Demencia/psicología , Hogares para Ancianos/tendencias , Humanos , Cuidados a Largo Plazo/métodos , Casas de Salud/tendencias
5.
BMJ ; 372: n532, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762262

RESUMEN

OBJECTIVE: To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia. MAIN OUTCOME MEASURES: Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses. RESULTS: Of 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference -2.93, 95% credible interval -4.35 to -1.52), cognitive stimulation combined with a cholinesterase inhibitor (-11.39, -18.38 to -3.93), massage and touch therapy (-9.03, -12.28 to -5.88), multidisciplinary care (-1.98, -3.80 to -0.16), occupational therapy (-2.59, -4.70 to -0.40), exercise combined with social interaction and cognitive stimulation (-12.37, -19.01 to -5.36), and reminiscence therapy (-2.30, -3.68 to -0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients). CONCLUSIONS: In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017050130.


Asunto(s)
Demencia/psicología , Depresión/terapia , Antidepresivos/uso terapéutico , Terapia Cognitivo-Conductual , Terapia Combinada , Depresión/etiología , Terapia por Ejercicio , Humanos , Metaanálisis en Red , Apoyo Social , Tratamiento de Tejidos Blandos
6.
Int J Equity Health ; 20(1): 76, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706774

RESUMEN

BACKGROUND: Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. METHODS: Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. RESULTS: Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. CONCLUSIONS: Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.


Asunto(s)
/epidemiología , Cuidadores/psicología , Demencia/psicología , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Servicio Social , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
Medicine (Baltimore) ; 100(11): e25225, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726020

RESUMEN

BACKGROUND: The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined. PURPOSE: This study designed to investigate these 3 validities of the CASI in people with dementia. METHODS: Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity. RESULTS: The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42-0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45-0.93). The t-test results revealed significant differences (P < .05) in the CASI total score and other domains except for the short-term memory domains. Four domains of the CASI showed noticeable ceiling effects (22.4-39.7%). CONCLUSIONS: The CASI has adequate ecological validity, good convergent validity, and acceptable discriminative validity in people with dementia. The 5 domains with nonsignificant differences or ceiling effects should only be used with caution to distinguish people with dementia.


Asunto(s)
Trastornos del Conocimiento/diagnóstico , Demencia/psicología , Evaluación Ecológica Momentánea/estadística & datos numéricos , Pruebas de Estado Mental y Demencia/estadística & datos numéricos , Anciano , Trastornos del Conocimiento/psicología , Evaluación Ecológica Momentánea/normas , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia/normas , Persona de Mediana Edad , Reproducibilidad de los Resultados
8.
Pharmacol Res ; 167: 105534, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33677103

RESUMEN

BACKGROUND: Antipsychotic medications are frequently prescribed to people with dementia to manage behavioural and psychological symptoms. Using a global federated research network, the objectives were to determine: 1) if COVID-19 is associated with 30-day thromboembolic events and mortality for people with dementia receiving antipsychotic medications; and 2) if the proportion of people with dementia receiving antipsychotics is higher during the COVID-19 pandemic compared to 2019. METHODS: A retrospective cohort study was conducted using TriNetX, a global federated health research network. The network was searched for people aged ≥ 65 years with dementia, COVID-19 and use of antipsychotics in the 30-days prior to COVID-19 recorded in electronic medical records between 20/01/2020 and 05/12/2020. These individuals were compared to historical controls from 2019 with dementia and use of antipsychotics in the 30-days before a visit to a participating healthcare organisation. Propensity score matching for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants was used to balance cohorts with and without COVID-19. RESULTS: Within the TriNetX network, 8414 individuals with COVID-19, dementia and use of antipsychotics and 31,963 historical controls were identified. After propensity score matching there were 8396 individuals with COVID-19 and 8396 historical controls. The cohorts were well balanced for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants. The odds of 30-day thromboembolic events and all-cause mortality were significantly higher in adults with COVID-19 (Odds Ratios: 1.36 (95% confidence interval (CI): 1.21-1.52) and 1.93 (1.71-2.17), respectively). The number of people with dementia with a visit to a participating healthcare organisation was lower between 20/01/2020 and 05/12/2020 (n = 165,447) compared to the same period in 2019 (n = 217,391), but the proportion receiving antipsychotics increased from 14.7% (95%CI: 14.6-14.9%) to 16.4% (95%CI: 16.2-16.5%), P < .0001. CONCLUSIONS: These findings add to the evidence base that during the COVID-19 pandemic there was an increase in the proportion of people with dementia receiving antipsychotics. The negative effects of antipsychotics in patients with dementia may be compounded by concomitant COVID-19.


Asunto(s)
Antipsicóticos/efectos adversos , Demencia/tratamiento farmacológico , Tromboembolia/epidemiología , Anciano , Anciano de 80 o más Años , /mortalidad , Demencia/diagnóstico , Demencia/mortalidad , Demencia/psicología , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tromboembolia/diagnóstico , Tromboembolia/mortalidad , Factores de Tiempo
9.
Clin Interv Aging ; 16: 363-378, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33664568

RESUMEN

Background: There is a need for interventions to foster and maintain independence for people with dementia to support community living, improve morale, and reduce stigma. We investigated a social intervention to promote living well and enhance independence for people with mild dementia. Methods: In this two arm parallel group, feasibility RCT at six sites in England, participants were randomized (1:1) to the PRIDE intervention (encompassing social, physical, and cognitive domains supported by a facilitator over three sessions) compared to usual care only. The main objective was to determine the feasibility of a main trial with respect to measures of recruitment, retention, and adherence to the intervention. Results: During a 7-month period, 402 people were invited to the trial, 148 were screened (37%, 95% confidence interval (CI)=32-42%), 137 were eligible at pre-consent, 94 consented to the trial (69% of those eligible, 95% CI=60-76%), and 92 were randomized (46 to each group). Of those allocated to the intervention, 42 (91%) received at least one of three intervention sessions. Outcome assessment follow-up visits were completed for 73 participants at 6 months (79%, 95% CI=70-87%), and this was similar for both groups. Conclusion: A large multi-center trial of the PRIDE intervention in community-dwelling people with mild dementia is feasible using systematic recruitment strategies. The intervention was successfully delivered and well received by participants. Findings from this study will be used to refine the design and processes for a definitive RCT. Trial Registration: ISRCTN, ISRCTN11288961, registered on 23 October 2018.


Asunto(s)
Demencia/psicología , Demencia/terapia , Vida Independiente/psicología , /métodos , Anciano , Anciano de 80 o más Años , Inglaterra/epidemiología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud
10.
J Prev Alzheimers Dis ; 8(2): 161-168, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33569562

RESUMEN

BACKGROUND: Although evidence suggests that subjective memory complaints (SMCs) could be a risk factor for dementia, the relationship between SMCs and objective memory performance remains controversial. Old adults with or without mild cognitive impairment (MCI) may represent a highly heterogeneous group, based partly on the demonstrated variability in the level of executive function among those individuals. It is reasonable to speculate that the accuracy of the memory-monitoring ability could be affected by the level of executive function in old adults. OBJECTIVE: This study investigated the effects of executive function level on the consistency between SMCs and objective memory performance while simultaneously considering demographic and clinical variables in nondemented older adults. SETTING: Participants were recruited from both the memory clinics and local communities. PARTICIPANTS: Participants comprised 65 cognitively normal (CN) older adults and 54 patients with MCI. MEASUREMENTS: Discrepancy scores between subjective memory evaluation and objective memory performance were calculated to determine the degree and directionality of the concordance between subjective and objective measures. Demographic, emotional, genetic, and clinical information as well as several executive function measurements were collected. RESULTS: The CN and MCI groups exhibited similar degrees of SMC; however, the patients with MCI were more likely to overestimate their objective memory ability, whereas the CN adults were more likely to underestimate their objective memory ability. The results also revealed that symptoms of depression, group membership, and the executive function level together predicted the discrepancy between the subjective and objective measures of memory function; however, the executive function level retained its unique predictive ability even after the symptoms of depression, group membership, and other factors were controlled for. CONCLUSION: Although both noncognitive and cognitive factors were necessary for consideration, the level of executive function may play a unique role in understanding the equivocal relationship of the concurrence between subjective complaints and objective function measures. Through a comprehensive evaluation, high-risk individuals (i.e., CN individuals heightened self-awareness of memory changes) may possibly be identified or provided with the necessary intervention during stages at which objective cognitive impairment remains clinically unapparent.


Asunto(s)
Disfunción Cognitiva/psicología , Demencia/psicología , Depresión/psicología , Función Ejecutiva/fisiología , Memoria/fisiología , Anciano , Cognición/fisiología , Demencia/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
11.
Clin Interv Aging ; 16: 231-244, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33574660

RESUMEN

Objective: To identify the barriers and facilitators to the implementation of a complex psychosocial intervention though a study exploring the experiences of participants, carers and interventionists during a trial. Methods: Individual semi-structured interviews were conducted with participants, their carers, and interventionists from a sample of recruiting sites that took part in the Journeying through Dementia randomized controlled trial (RCT). Interview data were transcribed and analysed using framework analysis. Co-researcher data analysis workshops were also conducted to explore researcher interpretations of the data through the lens of those with lived experience of dementia. Triangulation enabled comparison of findings from the interviews with findings from the co-researcher workshops. Results: Three main themes emerged from the interview data: being prepared; intervention engagement; and participation and outcomes from engagement. From these themes, a number of factors that can moderate delivery and receipt of the intervention as intended were identified. These were context and environment; readiness, training, skills and competencies of the workforce; identifying meaningful participation and relationships. Conclusion: This study highlighted that the observed benefit of the intervention was nuanced for each individual. Mechanisms of change were influenced by a range of individual, social and contextual factors. Future research should therefore consider how best to identify and measure the multifaceted interplay of mechanisms of change in complex interventions. Trial Registration: ISRCTN17993825.


Asunto(s)
Cuidadores/psicología , Demencia/psicología , Demencia/terapia , /métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa
12.
Clin Interv Aging ; 16: 281-289, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33623378

RESUMEN

Background: Depressive symptoms are common in people with dementia. Purpose: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia. Participants and Methods: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia ("participants") and their family caregivers ("proxies") participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall's tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann-Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group. Results: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The "high functional impairment" group had larger discrepancy scores and a lower level of agreement than the "low functional impairment" group. Conclusion: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.


Asunto(s)
Cuidadores/psicología , Demencia , Depresión , Vida Independiente , Anciano , Australia/epidemiología , Índice Médico de Cornell , Estudios Transversales , Demencia/diagnóstico , Demencia/epidemiología , Demencia/psicología , Depresión/diagnóstico , Depresión/etiología , Femenino , Humanos , Vida Independiente/psicología , Vida Independiente/estadística & datos numéricos , Masculino , Escalas de Valoración Psiquiátrica
13.
Medicine (Baltimore) ; 100(6): e24341, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578529

RESUMEN

BACKGROUND: Dementia is a major mental health problem worldwide, and an optimal anti-dementia drug that could modify its core symptoms has not been developed yet. Behavioral and psychological symptoms of dementia (BPSD), an important clinical manifestation of dementia, is closely related to disease burden, caregiver burden, and consequent social burden. In general, many experts and international guidelines prefer non-pharmacological interventions, including psychosocial intervention, and complementary and integrative medicine in the management of BPSD. However, in clinical settings, psychotropic drugs are frequently used; therefore, the need to establish and actively use effective non-pharmacological interventions is emphasized. Therefore, in this systematic review, we will evaluate the effectiveness and safety of acupuncture, a promising non-pharmacological complementary and integrative medicine, for BPSD. METHODS AND ANALYSIS: A comprehensive search will be conducted in 13 electronic medical databases. Regardless of its design, original clinical studies, such as randomized controlled clinical trials, nonrandomized controlled clinical trials, and before-after studies, will be included to assess the beneficial effects and safety of acupuncture on BPSD. The severity of BPSD symptoms assessed by the validated tool will be considered as a primary outcome. The secondary outcome included the total effective rate, daily living activities and quality of life of patients, burden and quality of life of caregiver, placement in a long-term care facility from home, and safety data. The study selection, data extraction, and quality assessment process were performed by 2 independent researchers. The methodological quality of the included studies will be assessed using validated tools according to its design, such as the Cochrane Collaboration's risk of bias tool. RevMan version 5.3 will be used to perform the meta-analysis, with mean differences for continuous outcomes and risk ratio for binary outcomes, and 95% confidence intervals. A fixed- or random-effects model will be used according to the heterogeneity and number of included studies. ETHICS AND DISSEMINATION: As this protocol is for a systematic review, ethical approval is not required. The results of the systematic review will be disseminated by the publication of a manuscript in a peer-reviewed journal or presentation at a relevant conference. REGISTRATION NUMBER: OSF (URL: https://osf.io/hu5ac), PROSPERO (CRD42020211005) (URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211005).


Asunto(s)
Terapia por Acupuntura , Demencia/terapia , Terapia por Acupuntura/métodos , Anciano , Demencia/psicología , Humanos
14.
J Stroke Cerebrovasc Dis ; 30(4): 105656, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33571877

RESUMEN

OBJECTIVES: Post-stroke complications affect stroke survivors across the world, although data on them are limited. We conducted a questionnaire survey to examine the real-world state and issues regarding post-stroke complications in Japan, which represents a super-aged society. MATERIALS AND METHODS: In 2018, a nationwide multi-center questionnaire survey was conducted in the top 500 Japanese hospitals regarding the number of stroke patients treated. Three questionnaires regarding post-stroke complications were mailed to the doctors responsible for stroke management. RESULTS: Responses were obtained from 251 hospitals (50.2%). The chief doctors responsible for stroke management answered the questionnaires. The number of stroke patients in the departments of neurology and neurosurgery was 338.3 ± 195.3 and 295.8 ± 121.8. Hospitals were classified using the categories secondary (n =142) and tertiary hospitals (n = 106); most hospitals were acute hospitals. Dementia was the most common complication (30.9%), followed by dysphagia (29.3%), and apathy (16.3%). Dementia was thought to be more common by neurologists than neurosurgeons, while apathy and bladder-rectal disorder were thought to be more common by neurosurgeons than neurologists (p = 0.001). The most difficult complication to treat was dysphagia (40.4%), followed by dementia (33.9%), epilepsy (4.1%), and fall (4.1%). Dementia was considered to lack clinical evidence regarding treatment (32.8%), followed by dysphagia (25.3%), and epilepsy (14.1%). Epilepsy was considered to lack clinical evidence among hospitals with a larger number of stroke cases (p = 0.044). CONCLUSION: This study revealed the current state and issues regarding post-stroke complications in Japan. Clinicians should be aware of the importance of post-stroke complications, although data on them remain unsatisfactory.


Asunto(s)
Afasia/epidemiología , Demencia/epidemiología , Epilepsia/epidemiología , Accidente Cerebrovascular/epidemiología , Accidentes por Caídas , Apatía , Afasia/fisiopatología , Afasia/terapia , Demencia/psicología , Demencia/terapia , Epilepsia/fisiopatología , Epilepsia/terapia , Encuestas de Atención de la Salud , Humanos , Japón/epidemiología , Salud Mental , Neurólogos , Neurocirujanos , Enfermedades del Recto/epidemiología , Especialización , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Enfermedades de la Vejiga Urinaria/epidemiología
15.
Neurology ; 96(12): e1620-e1631, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33536269

RESUMEN

OBJECTIVE: To determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia. METHODS: A retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model. RESULTS: We identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29-2.44) and death (HR 2.06, 2.02-2.10). CONCLUSIONS: DRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.


Asunto(s)
Demencia/complicaciones , Demencia/mortalidad , Demencia/psicología , Trastornos Psicóticos/etiología , Trastornos Psicóticos/mortalidad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Hogares para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Casas de Salud/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
16.
Hist Philos Life Sci ; 43(1): 21, 2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33587205

RESUMEN

In the paper, after clarifying terms such as 'identity', 'self' and 'personhood', I propose an empirical account of identity based on the notion of "whole phenotype". This move allows one to claim the persistence of the individuals before and after their being affected by dementia. Furthermore, I show how this account permits us to address significant questions related to demented individuals' loss of the capacity of moral decisions.


Asunto(s)
Demencia/psicología , Ego , Identificación Social , Humanos , Personeidad , Terminología como Asunto
17.
J Neurovirol ; 27(1): 154-159, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33528827

RESUMEN

As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.


Asunto(s)
/psicología , Tos/psicología , Demencia/psicología , Disnea/psicología , Síndrome de Fatiga Crónica/psicología , Fiebre/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Anciano , Antivirales/uso terapéutico , /tratamiento farmacológico , Tos/complicaciones , Tos/tratamiento farmacológico , Tos/virología , Demencia/complicaciones , Demencia/tratamiento farmacológico , Demencia/virología , Combinación de Medicamentos , Disnea/complicaciones , Disnea/tratamiento farmacológico , Disnea/virología , Síndrome de Fatiga Crónica/complicaciones , Síndrome de Fatiga Crónica/tratamiento farmacológico , Síndrome de Fatiga Crónica/virología , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Fiebre/virología , Humanos , Hidroxicloroquina/uso terapéutico , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Oseltamivir/uso terapéutico , Proyectos de Investigación , Ritonavir/uso terapéutico , /patogenicidad , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/tratamiento farmacológico , Trastornos por Estrés Postraumático/virología , Encuestas y Cuestionarios , Sobrevivientes/psicología
19.
Neurol Sci ; 42(3): 825-833, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33442845

RESUMEN

BACKGROUND: During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people's lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). METHODS: Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients' BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. RESULTS: A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. CONCLUSION: This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.


Asunto(s)
Síntomas Conductuales/etiología , Demencia/psicología , Cuarentena/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia , Masculino , Encuestas y Cuestionarios
20.
BMJ Open ; 11(1): e045889, 2021 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-33455941

RESUMEN

BACKGROUND: The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well-being. AIMS: To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak. METHODS: Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being. RESULTS: 377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3. CONCLUSIONS: Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic.


Asunto(s)
/psicología , Cuidadores/psicología , Demencia/psicología , Clausura de las Instituciones de Salud , Servicio Social , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Depresión/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Salud Mental , Persona de Mediana Edad , Apoyo Social , Reino Unido/epidemiología , Adulto Joven
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